Pharmacology, Toxicology, and Metabolism of Sennoside A, A Medicinal Plant-Derived Natural Compound

Sennoside A (SA) is a natural dianthrone glycoside mainly from medicinal plants of Senna and Rhubarb, and used as a folk traditional irritant laxative and slimming health food. Accumulating evidences suggest that SA possesses numerous pharmacological properties, such as laxative, anti-obesity, hypoglycemic, hepatoprotective, anti-fibrotic, anti-inflammatory, anti-tumor, anti-bacterial, anti-fungal, anti-viral, and anti-neurodegenerative activities. These pharmacological effects lay the foundation for its potential application in treating a variety of diseases. However, numerous published studies suggest that a long-term use of SA in large doses may have some adverse effects, including the occurrence of melanosis coli and carcinogenesis of colon cancer, thereby limiting its clinical use. It remains to be established whether SA or its metabolites are responsible for the pharmacological and toxicity effects. In this review, the latest advances in the pharmacology, toxicology, and metabolism of SA were summarizedbased on its biological characteristics and mechanism.

Melanosis coli in a peritoneal dialysis patient: a case report

Background Patients who undergo peritoneal dialysis (PD) are at risk of gut bacteria translocation leading to peritonitis when there is chronic diarrhea. Chronic diarrhea is defined as any course of diarrhea that lasts at least 4 weeks, which can be continuous or intermittent. Chronic diarrhea of any duration may cause dehydration, electrolyte imbalance, and life-threatening hypovolemic shock. In PD patients, excessive ultrafiltration from the exchanges, combined with severe gastrointestinal loss, may cause hypovolemic shock, electrolyte imbalance, and metabolic acidosis. There are multiple causes of chronic diarrhea in PD patients including infective causes, mitotic lesions, and rarely the regular and excessive use of laxatives, which is a diagnosis of exclusion. Case presentation We report a case of Melanau lady with chronic diarrhea secondary to laxative usage in a patient being treated with automated peritoneal dialysis (APD). The patient went into hypovolemic shock, but luckily did not contract peritonitis. A colonoscopy revealed brown to black discoloration of the colon, a feature suggestive of melanosis coli. A biopsy of the intestine further confirmed the diagnosis by histopathological examination. Withdrawal of laxatives and the introduction of probiotics improved the symptoms tremendously. Conclusions The chronic use of laxatives in PD patients can potentially lead to a devastating problem; thus, the management team must monitor treatment commencement appropriately.

Development, Disappearance, and Clinical Course of Melanosis Coli: Sex Differences in Progression of Severity

Background Melanosis coli (MC) is an acquired colorectal disorder visualized as colonic mucosa pigmentation. Disease severity is confirmed based on MC depth, shape, and coloration, although the clinical course is not fully understood. This study sought to clarify characteristics of MC development and disappearance and to demonstrate its clinical course and severity. Contributors to progression of MC grade were also explored. Methods To investigate the patient and clinical features of developing and disappearing MC, this study reviewed colonoscopy cases at a single institution over a 10-year period. The clinical course of MC grade was evaluated to explore the predictive factors of progressive MC. Kaplan–Meier analysis was used to determine the probability of disease progression, and the log-rank test was used to calculate equality of the clinical course. Results Of all MC cases, 17 developing and 11 disappearing cases were detected. Anthranoid laxative use was a key factor: 29.4% of developing cases used this agent before initial diagnosis of MC, whereas 27.2% of disappearing cases discontinued anthranoids before detection of MC disappearance. Among 70 grade I cases, progression to grade II occurred in 16 cases during mean follow-up of 3.67 ± 2.1 years. Male sex was more frequent in progressive than stable cases, and probability of progression was higher for male versus female cases. Conclusions An association between anthranoid administration and MC presence was detected; a sex difference in the clinical course was confirmed; and mild MC was found to progress in severity over 5 years.

Melanosis coli: a case report

Background Melanosis coli is a benign condition characterized by deposition of lipofuscin in colonic mucosa due to long-term laxative use. Case presentation Here I am reporting a case of an 85-year-old man who presented with constipation, with a history of long-term herbal medication intake as laxatives, and upon evaluation, he was found to have melanosis coli. Conclusion Melanosis coli is a common adverse effect of chronic laxative use which is more common in elderly population with constipation.